Primary intratracheal schwannoma resected during bronchoscopy using argon plasma coagulation

Abstract

A 63-year-old man presented with intermittent, progressively worsening dyspnoea associated with cough and blood-tinged sputum. Initial work-up showed left axis deviation on ECG, chest X-ray with an elevated left hemidiaphragm and a non-contrast CT chest that showed a multilobulated mass in the proximal trachea. Bronchoscopy showed a whitish-appearing lesion, which was then sampled and partially resected with pathology showing a schwannoma with no malignant cells. He felt partial relief post procedure; however, he presented a month later with similar symptoms of dyspnoea and a repeat CT scan showed enlargement of the mass in the same location. The patient underwent another flexible bronchoscopy and resection with argon plasma coagulation (APC)/electrocautery snare. APC/electrocautery is an effective interventional bronchoscopy technique that can be used to resect endoluminal lesions or extraluminal lesions that have infiltrated into the airway using flexible/rigid bronchoscopy. It is more cost-effective, safe, works well with vascular lesions and achieves excellent haemostasis as compared with Nd:YAG lasers.

Primary intratracheal schwannoma misdiagnosed as severe asthma in an adolescent: A case report

“…Due to the nonspecific nature of these symptoms, diagnosis of this rare condition is often delayed. The average time to diagnosis from the onset of initial symptoms was approximately 17 mo[ 7 , 12 ], and half the patients are reported to be misdiagnosed with asthma before the diagnosis is finally confirmed[ 13 ]. In the early stage, the tumor is small and grows slowly, often presenting as an irritating dry cough that can persist for months or even years.…”

“…Thoracic CT and 3-dimensional reconstruction are valuable in identifying the mass, assessing the location and size of the tracheal tumor, the degree of airway obstruction, the involvement of the mediastinum, and in determining treatment options[ 7 , 10 , 15 ]. The CT presentation of schwannomas is diverse, especially multiple forms of heterogeneous enhancement that can be observed on contrast-enhanced CT. Because of the lack of specific symptoms, intratracheal schwannomas can be easily misdiagnosed as other benign tumors of the trachea[ 10 ].…”

“…The tumor cells have the morphological characteristics of Schwann cells in terms of immunophenotype and ultrastructure. S-100(+) immunohistochemical staining also helps to confirm the diagnosis[ 7 , 16 ].…”

“…The current treatment options for intratracheal schwannomas include surgical resection plus airway reconstruction and interventional bronchoscopic resection[ 7 , 8 ]. The choice of treatment depends on tumor location, relationship of the mass with surrounding tissues, tracheal wall infiltration, risk of tracheal resection, and presence of extratracheal components[ 6 , 17 ].…”

Primary intratracheal neurilemmoma in a 10-year-old girl: A case report

“…Tracheal tumors are relatively rare in adults and uncommon in children[ 1 ]. About two-thirds of such tumors are malignant or moderately malignant, and the remaining one-third are benign lesions[ 2 ]. Tracheal neurilemmoma, also known as schwannoma, is a rare condition in adults that usually affects middle-aged people; however, it can also occur in children[ 3 ].…”